Low Back Pain vs. Self Care



Nonspecific low back pain (LBP) ranks as one of the most common and costly musculoskeletal disorders. The majority of costs related to low back pain are not from the initial complaint. The majority of costs stem from recurrence. (1-2) When low back pain recurs, patients return for further passive treatments initiating what some have qualified as a process of dependence. (3) The problem with this approach is that most cases of non-specific low back pain are not a pain syndrome and not a specific injury. They are a deconditioning syndrome, where normal wear and tear on the back occasionally overcomes the body’s capacity to cope with daily stresses, and an episode of pain flares up.

Research suggests physical therapy can be most effective when care begins shortly after a back pain flare up. In fact, research shows that when physical therapy begins within 14 days of a primary care consult for back pain, the following benefits accrue: (4-5)

· Medical costs reduced by $3,058 per patient

· Use of advanced imaging reduced by 74%

· Need for surgery reduced by 55%

· Need for injections reduced by 58%

· Use of opioids reduced by 22%

References:

  1. Machado L, Kamper S, Herbert R, et al. Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials. Rheumatology (Oxford). 2009; 48: 520-7.
  2. Costa L, Maher C, McAuley J, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ. 2009; 339: b3829.
  3. Oliveira V, Ferreira P, Maher C, et al. Effectiveness of self-management of low back pain: systematic review with meta-analysis. Arthritis Care & Research. 2012; 64 (11): 1739-1748.
  4. Fritz J, Childs J, Wainner R, Flynn T. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs.  Spine. 2012; 37 (25): 2114-21.
  5. Gelhorn A, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine. 2012; 37 (9): 775-782.
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